Better diagnosis could aid battle against pelvic inflammatory disease

Abstract

This document presented the highlights of a 3 day conference on PID (pelvic inflammatory disease) recently held at the Center for Disease Control in Atlanta Georgia. In the U.S. each year physicians treat 212000 patients for salpingitis PID patients spend a total of 1 1/2 million days in the hospital and 900 women die from PID. 20% of all women who have had salpingitis subsequently become infertile. Women with a history of salpingitis have a 6 to 10 times greater risk of having an ectopic pregnancy than women without a history of salpingitis. PID is also a serious problem in most developing countries. For example in Gabon an estimated 1/3 of all women are infertile as a result of PID. In the past attention was directed primarily toward treating salpingitis caused by Neisseria gonorrhoeae; yet in a large proportion of cases other pathogens are involved. In Sweden a recent study demonstrated that Chlamydia trachomatis was involved in 60% of the investigated cases of salpingitis and Mycoplasma hominis was involved in 10-15% of the cases. In the U.S. only 50% of the cervical cultures from symptomatic women are gonorrhea positive and attention is now being directed toward uncovering the nongonococcal causes of PID. Salpingitis is difficult to diagnosis since cervical cultures do not always reveal the presence of pathogens in the pelvic andexa and lower abdominal pain is not always experienced by the patient. Lars Westrom of Sweden advocates the use of laparoscopy to diagnose salpingitis. This technique permits the physician to visually examine the pelvic organs and to obtain cultures from infected tissue and peritoneal exudate. In the U.S. many physicians hestitate to use laparoscopy for this purpose due to the risks associated with the use of this technique. Appropriate drug regimens for treating salpingitis were also discussed.